Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 48812 | CO |
NPI | 1285780874 |
---|---|
Provider Name | Alison Bible Allen |
First Address | Basalt, CO 81621-7402 |
Second Address | Basalt, CO 81621-7402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 05/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12095335 | CAQH ID (01) | CO |
48812 | CO MEDICAL LICENSE (01) | CO |